Clinical research status and progress of central retinal artery occlusion_Chinese Journal of Ocular Fundus Diseases

Authors：

Miao Na ,  Fan Wei

Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China;

Corresponding author：

Fan Wei, Email: fanwei55@yahoo.com

Keywords：

Retinal artery occlusion/therapy; Retinal artery occlusion/complications; Risk factors; Review

DOI：

10.3760/cma.j.issn.1005-1015.2018.03.023

Video：

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Embolus occlusion in the retinal artery is the most common cause of central retinal artery occlusion (CRAO), while hypertension is the most common risk factor of CRAO, and ipsilateral carotid artery stenosis is the most significant risk factor in CRAO. Current clinical treatments include conservative treatments such as dilation of blood vessels and lowering the intraocular pressure (IOP), as well as aggressive treatments like intravenous thrombolysis and Nd:YAG laser. Both thrombolysis and Nd:YAG laser treatment can improve the visual acuity of CRAO patients, but because of its lack of randomized controlled trials, further clinical studies are needed to determine their efficacy and safety. CRAO patients may have vascular embolism at other sites in the body, and may cause different degrees of cardiovascular and cerebrovascular events. The probability of secondary ocular neovascularization following the occurrence of these events is 2.5% to 31.6%. In addition to eye care, clinicians should also focus more on preventing cardiovascular and cerebrovascular events, and focus on the screening and active treatment of systemic risk factors to reduce the incidence and mortality of cardiovascular and cerebrovascular events.

Citation： Miao Na, Fan Wei. Clinical research status and progress of central retinal artery occlusion. Chinese Journal of Ocular Fundus Diseases, 2018, 34(3): 296-299. doi: 10.3760/cma.j.issn.1005-1015.2018.03.023 Copy

1.	Olsen TW, Pulido JS, Folk JC, et al. Retinal and ophthalmic artery occlusions preferred practice pattern(R)[J]. Ophthalmology, 2017, 124(2): 120-143. DOI: 10.1016/j.ophtha.2016.09.024.
2.	Ahn SJ, Woo SJ, Park KH, et al. Retinal and choroidal changes and visual outcome in central retinal artery occlusion: an optical coherence tomography study[J]. Am J Ophthalmol, 2015, 159(4): 667-676. DOI: 10.1016/j.ajo.2015.01.001.
3.	Furashova O, Matthe E. Retinal changes in different grades of retinal artery occlusion: an optical coherence tomography study[J]. Invest Ophthalmol Vis Sci, 2017, 58(12): 5209-5216. DOI: 10.1167/iovs.17-22411.
4.	Cugati S, Varma DD, Chen CS, et al. Treatment options for central retinal artery occlusion[J]. Curr Treat Options Neurol, 2013, 15(1): 63-77. DOI: 10.1007/s11940-012-0202-9.
5.	Rudkin AK, Lee AW, Chen CS. Vascular risk factors for central retinal artery occlusion[J]. Eye (Lond), 2010, 24(4): 678-681. DOI: 10.1038/eye.2009.142.
6.	Varma DD, Cugati S, Lee AW, et al. A review of central retinal artery occlusion: clinical presentation and management[J]. Eye (Lond), 2013, 27(6): 688-697. DOI: 10.1038/eye.2013.25.
7.	卢宁, 李建军. 视网膜动脉阻塞治疗的新希望[J]. 眼科, 2007, 16(4): 217-219. DOI: 10.3969/j.issn.1004-4469.2007.04.001.Lu N, Li JJ. New challenge in the treatment of retinal artery occlusion [J]. Ophthalmol CHN, 2007, 16(4): 217-219. DOI: 10.3969/j.issn.1004-4469.2007.04.001.
8.	Leavitt JA, Larson TA, Hodge DO, et al. The incidence of central retinal artery occlusion in Olmsted County, Minnesota[J]. Am J Ophthalmol, 2011, 152(5): 820-823. DOI: 10.1016/j.ajo.2011.05.005.
9.	Callizo J, Feltgen N, Pantenburg S, et al. Cardiovascular risk factors in central retinal artery occlusion: results of a prospective and standardized medical examination[J]. Ophthalmology, 2015, 122(9): 1881-1888. DOI: 10.1016/j.ophtha.2015.05.044.
10.	Leisser C. Are there differences between internal carotid artery and aortic arch plaques among patients with retinal artery occlusion and anterior ischaemic optic neuropathy?[J]. Klin Monbl Augenheilkd, 2014, 231(11): 1084-1087. DOI: 10.1055/s-0034-1368574.
11.	Schmidt DP, Schulte-Mönting J, Schumacher M. Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment[J]. AJNR Am J Neuroradiol, 2002, 23(8): 1301-1307.
12.	Schrag M, Youn T, Schindler J, et al. Intravenous fibrinolytic therapy in central retinal artery occlusion: a patient-level meta-analysis[J]. JAMA Neurol, 2015, 72(10): 1148-1154. DOI: 10.1001/jamaneurol.2015.1578.
13.	李逸丰, 魏文斌. 视网膜动脉阻塞的综合治疗[J]. 中华实验眼科杂志, 2017, 35(1): 93-96. DOI: 10.3760/cma.j.issn.2095-0160.2017.01.020.Li YF, Wei WB. Comprehensive therapy for retinal artery occlusion[J]. Chin J Exp Ophthalmol, 2017, 35(1): 93-96. DOI: 10.3760/cma.j.issn.2095-0160.2017.01.020.
14.	Atebara NH, Brown GC, Cater J. Efficacy of anterior chamber paracentesis and Carbogen in treating acute nonarteritic central retinal artery occlusion[J]. Ophthalmology, 1995, 102(12): 2029.
15.	Dattilo M, Biousse V, Newman NJ. Update on the management of central retinal artery occlusion[J]. Neurol Clin, 2017, 35(1): 83-100. DOI: 10.1016/j.ncl.2016.08.013.
16.	Bmbs AKR, Fracp AWL, Aldrich E, et al. Clinical characteristics and outcome of current standard management of central retinal artery occlusion[J]. Clin Exp Ophthalmol, 2010, 38(5): 496-501. DOI: 10.1111/j.1442-9071.2010.02280.x.
17.	Rumelt S, Dorenboim Y, Rehany U. Aggressive systematic treatment for central retinal artery occlusion[J]. Am J Ophthalmol, 1999, 128(6): 733-738.
18.	Schumacher M, Schmidt D, Jurklies B, et al. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial[J]. Ophthalmology, 2010, 117(7): 1367-1375. DOI: 10.1016/j.ophtha.2010.03.061.
19.	Man V, Hecht I, Talitman M, et al. Treatment of retinal artery occlusion using transluminal Nd: YAG laser: a systematic review and meta-analysis[J]. Graefe's Arch Clin Exp Ophthalmol, 2017, 255(10): 1869-1877. DOI: 10.1007/s00417-017-3777-8.
20.	Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century a statement for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013, 44(7): 2064-2089. DOI: 10.1161/STR.0b013e318296aeca.
21.	Park SJ, Choi NK, Yang BR, et al. Risk and risk periods for stroke and acute myocardial infarction in patients with central retinal artery occlusion[J]. Ophthalmology, 2015, 122(11): 2336-2343. DOI: 10.1016/j.ophtha.2015.07.018.
22.	Rim TH, Han J, Choi YS, et al. Retinal artery occlusion and the risk of stroke development: twelve-year nationwide cohort study[J]. Stroke, 2016, 47(2): 376-382. DOI: 10.1161/STROKEAHA.115.010828.
23.	Chang YS, Jan RL, Weng SF, et al. Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study[J]. Am J Ophthalmol, 2012, 154(4): 645-652. DOI: 10.1016/j.ajo.2012.03.046.
24.	Atkins EJ, Bruce BB, Newman NJ, et al. Translation of clinical studies to clinical practice: survey on the treatment of central retinal artery occlusion[J]. Am J Ophthalmol, 2009, 148(1): 172-173. DOI: 10.1016/j.ajo.2009.03.020.
25.	Lee J, Kim SW, Lee SC, et al. Co-occurrence of acute retinal artery occlusion and acute ischemic stroke: diffusion-weighted magnetic resonance imaging study[J]. Am J Ophthalmol, 2014, 157(6): 1231-1238. DOI: 10.1016/j.ajo.2014.01.033.
26.	Lauda F, Neugebauer H, Reiber L, et al. Acute silent brain infarction in monocular visual loss of ischemic origin[J]. Cerebrovasc Dis, 2015, 40(3-4): 151-156. DOI: 10.1159/000437274.
27.	Helenius J, Arsava EM, Goldstein JN, et al. Concurrent acute brain infarcts in patients with monocular visual loss[J]. Ann Neurol, 2012, 72(2): 286-293. DOI: 10.1002/ana.23597.

1. Olsen TW, Pulido JS, Folk JC, et al. Retinal and ophthalmic artery occlusions preferred practice pattern(R)[J]. Ophthalmology, 2017, 124(2): 120-143. DOI: 10.1016/j.ophtha.2016.09.024.
2. Ahn SJ, Woo SJ, Park KH, et al. Retinal and choroidal changes and visual outcome in central retinal artery occlusion: an optical coherence tomography study[J]. Am J Ophthalmol, 2015, 159(4): 667-676. DOI: 10.1016/j.ajo.2015.01.001.
3. Furashova O, Matthe E. Retinal changes in different grades of retinal artery occlusion: an optical coherence tomography study[J]. Invest Ophthalmol Vis Sci, 2017, 58(12): 5209-5216. DOI: 10.1167/iovs.17-22411.
4. Cugati S, Varma DD, Chen CS, et al. Treatment options for central retinal artery occlusion[J]. Curr Treat Options Neurol, 2013, 15(1): 63-77. DOI: 10.1007/s11940-012-0202-9.
5. Rudkin AK, Lee AW, Chen CS. Vascular risk factors for central retinal artery occlusion[J]. Eye (Lond), 2010, 24(4): 678-681. DOI: 10.1038/eye.2009.142.
6. Varma DD, Cugati S, Lee AW, et al. A review of central retinal artery occlusion: clinical presentation and management[J]. Eye (Lond), 2013, 27(6): 688-697. DOI: 10.1038/eye.2013.25.
7. 卢宁, 李建军. 视网膜动脉阻塞治疗的新希望[J]. 眼科, 2007, 16(4): 217-219. DOI: 10.3969/j.issn.1004-4469.2007.04.001.Lu N, Li JJ. New challenge in the treatment of retinal artery occlusion [J]. Ophthalmol CHN, 2007, 16(4): 217-219. DOI: 10.3969/j.issn.1004-4469.2007.04.001.
8. Leavitt JA, Larson TA, Hodge DO, et al. The incidence of central retinal artery occlusion in Olmsted County, Minnesota[J]. Am J Ophthalmol, 2011, 152(5): 820-823. DOI: 10.1016/j.ajo.2011.05.005.
9. Callizo J, Feltgen N, Pantenburg S, et al. Cardiovascular risk factors in central retinal artery occlusion: results of a prospective and standardized medical examination[J]. Ophthalmology, 2015, 122(9): 1881-1888. DOI: 10.1016/j.ophtha.2015.05.044.
10. Leisser C. Are there differences between internal carotid artery and aortic arch plaques among patients with retinal artery occlusion and anterior ischaemic optic neuropathy?[J]. Klin Monbl Augenheilkd, 2014, 231(11): 1084-1087. DOI: 10.1055/s-0034-1368574.
11. Schmidt DP, Schulte-Mönting J, Schumacher M. Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment[J]. AJNR Am J Neuroradiol, 2002, 23(8): 1301-1307.
12. Schrag M, Youn T, Schindler J, et al. Intravenous fibrinolytic therapy in central retinal artery occlusion: a patient-level meta-analysis[J]. JAMA Neurol, 2015, 72(10): 1148-1154. DOI: 10.1001/jamaneurol.2015.1578.
13. 李逸丰, 魏文斌. 视网膜动脉阻塞的综合治疗[J]. 中华实验眼科杂志, 2017, 35(1): 93-96. DOI: 10.3760/cma.j.issn.2095-0160.2017.01.020.Li YF, Wei WB. Comprehensive therapy for retinal artery occlusion[J]. Chin J Exp Ophthalmol, 2017, 35(1): 93-96. DOI: 10.3760/cma.j.issn.2095-0160.2017.01.020.
14. Atebara NH, Brown GC, Cater J. Efficacy of anterior chamber paracentesis and Carbogen in treating acute nonarteritic central retinal artery occlusion[J]. Ophthalmology, 1995, 102(12): 2029.
15. Dattilo M, Biousse V, Newman NJ. Update on the management of central retinal artery occlusion[J]. Neurol Clin, 2017, 35(1): 83-100. DOI: 10.1016/j.ncl.2016.08.013.
16. Bmbs AKR, Fracp AWL, Aldrich E, et al. Clinical characteristics and outcome of current standard management of central retinal artery occlusion[J]. Clin Exp Ophthalmol, 2010, 38(5): 496-501. DOI: 10.1111/j.1442-9071.2010.02280.x.
17. Rumelt S, Dorenboim Y, Rehany U. Aggressive systematic treatment for central retinal artery occlusion[J]. Am J Ophthalmol, 1999, 128(6): 733-738.
18. Schumacher M, Schmidt D, Jurklies B, et al. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial[J]. Ophthalmology, 2010, 117(7): 1367-1375. DOI: 10.1016/j.ophtha.2010.03.061.
19. Man V, Hecht I, Talitman M, et al. Treatment of retinal artery occlusion using transluminal Nd: YAG laser: a systematic review and meta-analysis[J]. Graefe's Arch Clin Exp Ophthalmol, 2017, 255(10): 1869-1877. DOI: 10.1007/s00417-017-3777-8.
20. Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century a statement for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013, 44(7): 2064-2089. DOI: 10.1161/STR.0b013e318296aeca.
21. Park SJ, Choi NK, Yang BR, et al. Risk and risk periods for stroke and acute myocardial infarction in patients with central retinal artery occlusion[J]. Ophthalmology, 2015, 122(11): 2336-2343. DOI: 10.1016/j.ophtha.2015.07.018.
22. Rim TH, Han J, Choi YS, et al. Retinal artery occlusion and the risk of stroke development: twelve-year nationwide cohort study[J]. Stroke, 2016, 47(2): 376-382. DOI: 10.1161/STROKEAHA.115.010828.
23. Chang YS, Jan RL, Weng SF, et al. Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study[J]. Am J Ophthalmol, 2012, 154(4): 645-652. DOI: 10.1016/j.ajo.2012.03.046.
24. Atkins EJ, Bruce BB, Newman NJ, et al. Translation of clinical studies to clinical practice: survey on the treatment of central retinal artery occlusion[J]. Am J Ophthalmol, 2009, 148(1): 172-173. DOI: 10.1016/j.ajo.2009.03.020.
25. Lee J, Kim SW, Lee SC, et al. Co-occurrence of acute retinal artery occlusion and acute ischemic stroke: diffusion-weighted magnetic resonance imaging study[J]. Am J Ophthalmol, 2014, 157(6): 1231-1238. DOI: 10.1016/j.ajo.2014.01.033.
26. Lauda F, Neugebauer H, Reiber L, et al. Acute silent brain infarction in monocular visual loss of ischemic origin[J]. Cerebrovasc Dis, 2015, 40(3-4): 151-156. DOI: 10.1159/000437274.
27. Helenius J, Arsava EM, Goldstein JN, et al. Concurrent acute brain infarcts in patients with monocular visual loss[J]. Ann Neurol, 2012, 72(2): 286-293. DOI: 10.1002/ana.23597.

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